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The patient should sit for several minutes in a quiet room before BP measurements are taken. Pain, stress, a full urinary bladder, a recent meal, and talking or active listening during measurement affect BP. Having smoked a cigarette within 15–20 minutes can elevate the BP by 5–20 mm Hg.

Take at least 2 measurements spaced by 1–2 minutes and additional measurements if the first 2 are quite different.

Using a bladder that is too narrow yields false high readings. Instead of the standard cuff (12–13 cm long, 35 cm wide) use an appropriate larger cuff in patients with increased arm circumference.

Do not deflate the cuff too rapidly, otherwise individual Korotkoff sounds are missed and too low a value is measured; start with a deflation rate of 2 mm/s.

Measure the heart rate by palpation and watch out for arrhythmia, which mandates repeated BP measurements.

At the first visit, measure BP in both arms and take the higher value as the reference; measure BP at 1 minute and 5 minutes after standing upright if the patient has a disorder that frequently causes orthostatic hypotension.

The most recent Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP (JNC 7) classifies BP as follows, based on the mean of 2 seated BP measurements on each of 2 or more office visits:

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